Provider Demographics
NPI:1073516142
Name:GOTLIEB, VLADIMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:GOTLIEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 62ND DR
Mailing Address - Street 2:SUITE LA
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1261
Mailing Address - Country:US
Mailing Address - Phone:718-830-6333
Mailing Address - Fax:718-830-6355
Practice Address - Street 1:10850 62ND DR
Practice Address - Street 2:SUITE LA
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1261
Practice Address - Country:US
Practice Address - Phone:718-830-6333
Practice Address - Fax:718-830-6355
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218369207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2513705OtherGHI
NY218369OtherHIP
NYP3043079OtherOXFORD
NY7799489OtherAETNA
NY199AB1OtherBCBS
NY218369OtherHIP
NYH97710Medicare UPIN